Application of wire reduction technique guided by minimally invasive wire introducer in treatment of difficult-reducing intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Jinxi ¹ , HE Changren ¹ , LIU Fang ¹ ,  WEN Fei ²

1. Department of Orthopaedics, the Second People’s Hospital of Yueyang City, Yueyang Hunan, 414000, P.R.China;
2. Department of Orthopaedics, the Rongchang District People’s Hospital, Rongchang Chongqing, 402460, P.R.China;

Corresponding author：

WEN Fei, Email: 214707603@qq.com

Keywords：

Intertrochanteric fracture; intramedullary nail; minimally invasive wire introducer; reduction

DOI：

10.7507/1002-1892.201905025

Video：

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Objective To investigate the application effect of wire reduction technique guided by minimally invasive wire introducer in the treatment of difficult-reducing intertrochanteric fractures.Methods Between April 2016 and April 2018, 30 patients with intertrochanteric fractures who had difficulty in closed reduction under the traction bed were treated. There were 17 males and 13 females, aged from 60 to 93 years (mean, 72 years). The causes of injury included falls in 22 cases and traffic accidents in 8 cases. The fractures were classified according to AO/Orthopaedic Trauma Association (AO/OTA) classification: 12 cases of type A1, 12 cases of type A2, and 6 cases of type A3. Intramedullary nail incision and self-made minimally invasive wire introducer were used to assist reduction of intertrochanteric fracture, and then intramedullary nail internal fixation was performed.Results The operation time was 30-70 minutes, with an average of 45 minutes. The intraoperative blood loss was 100-210 mL, with an average of 160 mL. One case died of cerebrovascular accident at 3 months after operation; the remaining 29 cases were followed up 6-18 months, with an average of 8.3 months. Postoperative DR reexamination showed that all patients had a good reduction in the fracture end, no retraction, fracture displacement, hip valgus deformity, and other serious complications occurred. The fracture was completely healed and the healing time was 3-8 months, with an average of 6 months. At 3 months after operation, the visual analogue scale (VAS) score was 1-3, with an averge of 1.7. According to Harris functional score of hip joint, 26 cases were excellent and 3 cases were good.Conclusion For the difficult-reducing intertrochanteric fractures, minimally invasive wire introducer is used to insert steel wire into the incision of head and neck nail for assisted reduction, which can achieve satisfactory reduction results and improve the effectiveness of intertrochanteric fracture.

Citation： HU Jinxi, HE Changren, LIU Fang, WEN Fei. Application of wire reduction technique guided by minimally invasive wire introducer in treatment of difficult-reducing intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(10): 1245-1249. doi: 10.7507/1002-1892.201905025 Copy

1.	Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int, 2013, 24(10): 2728-2728.
2.	Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
3.	李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
4.	唐佩福. 股骨转子间骨折的治疗进展与策略. 中华创伤骨科杂志, 2017, 19(2): 93-94.
5.	Jia L, Zhang K, Wang ZG, et al. Proximal femoral nail antirotation internal fixation in treating intertrochanteric femoral fractures of elderly subjects. J Biol Regul Homeost Agents, 2017, 31(2): 329-334.
6.	Hélin M, Pelissier A, Boyer P, et al. Does the PFNA^TM nail limit impaction in unstable intertrochanteric femoral fracture? A 115 case-control series. Orthop Traumatol Surg Res, 2015, 101(1): 45-49.
7.	Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand, 2003, 74(1): 53-58.
8.	Cho SH, Lee SH, Cho HL, et al. Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO Type 31-A2): short-term clinical results. Clin Orthop Surg, 2011, 3(2): 107-113.
9.	Kim GM, Nam KW, Seo KB, et al. Wiring technique for lesser trochanter fixation in proximal IM nailing of unstable intertrochanteric fractures: A modified candy-package wiring technique. Injury, 2017, 48(2): 406-413.
10.	张睿, 罗鹏, 胡炜, 等. 新型股骨近端内侧支撑钢板治疗股骨反转子间骨折的生物力学研究. 中国修复重建外科杂志, 2017, 31(2): 165-170.
11.	佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 2017, 19(2): 109-114.
12.	Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury, 2013, 44(2): 168-174.
13.	Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg (Am), 1984, 66(4): 529-539.
14.	杨伟, 魏文东, 王欢, 等. 骨钩辅助 PFNA 治疗不稳定股骨转子间骨折. 重庆医学, 2018, 47(12): 1675-1677.
15.	王亮. 股骨大粗隆外展肌复合体及其临床意义. 中国骨与关节损伤杂志, 2015, 30(2): 223-224.

1. Stevens JA, Rudd RA. The impact of decreasing U.S. hip fracture rates on future hip fracture estimates. Osteoporos Int, 2013, 24(10): 2728-2728.
2. Ma KL, Wang X, Luan FJ, et al. Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res, 2014, 100(8): 859-866.
3. 李建涛, 张里程, 唐佩福. 股骨粗隆间骨折治疗理念与内固定器械的发展概述. 中国修复重建外科杂志, 2019, 33(1): 1-7.
4. 唐佩福. 股骨转子间骨折的治疗进展与策略. 中华创伤骨科杂志, 2017, 19(2): 93-94.
5. Jia L, Zhang K, Wang ZG, et al. Proximal femoral nail antirotation internal fixation in treating intertrochanteric femoral fractures of elderly subjects. J Biol Regul Homeost Agents, 2017, 31(2): 329-334.
6. Hélin M, Pelissier A, Boyer P, et al. Does the PFNA^TM nail limit impaction in unstable intertrochanteric femoral fracture? A 115 case-control series. Orthop Traumatol Surg Res, 2015, 101(1): 45-49.
7. Boldin C, Seibert FJ, Fankhauser F, et al. The proximal femoral nail (PFN)--a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand, 2003, 74(1): 53-58.
8. Cho SH, Lee SH, Cho HL, et al. Additional fixations for sliding hip screws in treating unstable pertrochanteric femoral fractures (AO Type 31-A2): short-term clinical results. Clin Orthop Surg, 2011, 3(2): 107-113.
9. Kim GM, Nam KW, Seo KB, et al. Wiring technique for lesser trochanter fixation in proximal IM nailing of unstable intertrochanteric fractures: A modified candy-package wiring technique. Injury, 2017, 48(2): 406-413.
10. 张睿, 罗鹏, 胡炜, 等. 新型股骨近端内侧支撑钢板治疗股骨反转子间骨折的生物力学研究. 中国修复重建外科杂志, 2017, 31(2): 165-170.
11. 佟大可, 丁文彬, 王光超, 等. 难复性股骨转子间骨折的临床分型与治疗. 中华创伤骨科杂志, 2017, 19(2): 109-114.
12. Apivatthakakul T, Phaliphot J, Leuvitoonvechkit S. Percutaneous cerclage wiring, does it disrupt femoral blood supply? A cadaveric injection study. Injury, 2013, 44(2): 168-174.
13. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg (Am), 1984, 66(4): 529-539.
14. 杨伟, 魏文东, 王欢, 等. 骨钩辅助 PFNA 治疗不稳定股骨转子间骨折. 重庆医学, 2018, 47(12): 1675-1677.
15. 王亮. 股骨大粗隆外展肌复合体及其临床意义. 中国骨与关节损伤杂志, 2015, 30(2): 223-224.

Chinese Journal of Reparative and Reconstructive Surgery

Application of wire reduction technique guided by minimally invasive wire introducer in treatment of difficult-reducing intertrochanteric fractures

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